AI In Revenue Cycle Management: Automation and artificial intelligence (AI) are crucial for enhancing revenue cycle performance. Revennue cycle management companies are looking into methods to take advantage of AI’s disruptive potential, which is creating waves across many industries.
Prior authorization is one of the best uses of AI in healthcare, according to executives in the industry, and there are many more use cases as well. Prior authorizations, however, are only one of the time-consuming procedures in the revenue cycle, a section of healthcare that involves a lot of transactions.
In the current healthcare sector, there are many obstacles to revenue cycle management, such as insurance denials and rising expenses faster than reimbursements. Hospitals and medical billing companies in US believe that integrating AI in revenue cycle management could be a solution to some of these problems.
Let’s examine how AI can be used to modernize revenue cycle management and how hospitals and health systems can employ such innovative technology:
Automating a range of processes to improve Revenue Cycle Management
- With the use of automation, many high-volume, repetitive, and boring jobs may be finish with accuracy, enabling hospitals to increase production at a significantly reduced cost. Hospitals can then reinvest these resources into tasks that call for empathy, creativity, and complicated cognition, which require a more human touch.
- A survey found that automating crucial revenue cycle tasks might result in savings for providers of 9.8 billion USD.
- With the use of AI, organizations can change a few things regarding their revenue cycle personnel and strategy.
- AI helps businesses deal with the labour problem.
- Retaining talent is vital in competitive marketplaces, and hospitals may do this with the aid of AI by rewarding devoted personnel with increasingly significant roles when they become unnecessary for tasks that can be automated.
- AI enables healthcare organizations to outsource tasks more strategically.
Estimating the likelihood of a claim being denied
It is possible to anticipate claim denials using an AI-driven revenue cycle management strategy. High claim denial rates are problematic for hospitals and other service organisations for a number of reasons, including human error and constantly changing insurance criteria. Insurance denials reportedly cost hospitals more than $260 billion annually.
Recognize patterns in claim denials
Hospitals and healthcare organisations are now better equipped to identify the causes of prior claim denials from payers and identify trends thanks to the adoption of AI technologies. A healthcare firm can predict denials and fix issues before claims are submitted thanks to analytics of claim denials, which lowers denial rates and boosts income.
NLP with RCM
By streamlining and improving manual operations, AI and automation can save expenses for hospitals and healthcare organizations. Healthcare natural language processing AI is another use that has the potential to revolutionize the revenue cycle. NLP makes it possible for software programmes to handle and evaluate unstructured data, like free-text notes made by doctors in an EHR. The use of NLP in RCM can enhance clinical documentation and coding.
After learning about the advantages of AI, one should consider the question, “Can AI be used to optimize RCM?
Now, let’s take a closer look at this feature:
AI’s potential to improve RCM
Numerous healthcare providers are utilizing AI technology to give patients with improved care for conditions including COVID-19, cancer, and even sleep issues.
The revenue cycle contains an abundance of tagged data, which means values are codified to data points to indicate certain events. For instance, attributes of a patient’s diagnosis. AI is efficient at evaluating those variables and coming up with an ever-improving success rate of getting to the right outcome against any of those process steps.
AI can imitate intelligent human behavior through various algorithms that find patterns and plan future actions to produce a positive outcome. Hence AI can effectively address various revenue cycle management issues, such as prior authorizations, claim status checks, and out-of-pocket cost estimates while getting the information that needs human intervention at the right time.
In the revenue cycle, some of these processes include checking the status of claims, working denials, or reviewing eligibility are time-consuming and copy-and-paste intensive by automating such a task, a healthcare organization can address every patient account, regardless of the dollar amount attached to it.
AI helps in keeping the privacy and security of patient’s information by controlling the sending of sensitive patient information. It eliminates the need for at least one set of eyes on the data and enables information to send securely and accessed, meaning hospitals have greater control over who accesses patient data and where it goes.
Therefore, AI in the revenue cycle mainly deals with revenue integrity, compliance, and optimal reimbursement. The technology allows hospitals to repurpose employees and mitigate revenue leakage in ways that require more critical thinking.
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AI for healthcare staff
AI helps hospitals operate in smart ways. With the help of automation, hospitals can offer a productive environment to its employees in which employees get authority to focus solely on work that requires the human touch.
AI system helps staff in a couple of important ways:
- Completes nearly 100 percent of eligibility checks on the front-end of the revenue cycle
- Highlight changes in payers’ reimbursement policies, which helps employees act sooner to reduce AR days or notice variations in accounts much earlier.
However, justifying spending thousands of dollars on new technology such as AI will be difficult for instance, consider the EHR system, a single hospital stands to spend millions of dollars on a new system. But this is the wrong way to think about automation. Hospital leaders shouldn’t think about AI and automation as another price tag, but as a path to savings. These leaders should carefully examine the business case for AI-driven revenue cycle management and explore small-scale innovations with the potential for a strong return.
AI-based RCM is a necessity for a healthcare organization to address the challenges and opportunities of the modern revenue cycle. We have a team of experts who understand the technology and its benefits. We offer RCM services keeping in mind the latest advancement in it. Contact us to know more.
